Answers · Mansher Singh, MD, FACS
What Can Go Wrong With Eyelid Surgery?
An honest account of blepharoplasty complications: dry eye, ectropion and lid retraction, asymmetry, over-resection, scarring, and the rare vision threatening event.
Updated September 2026 · Reviewed by Mansher Singh, MD, FACS
Short answer
The common problems are dry eye, asymmetry, and residual or excess skin. The more serious ones are lower lid retraction or ectropion from over-resection and loss of lid support, inability to close the eye after aggressive upper lid excision, and, rarely, retrobulbar hematoma, which is a vision threatening emergency.
TL;DR
- The common problems are dry eye, asymmetry, and residual or excess skin.
- How common is dry eye after blepharoplasty? Temporary dryness is common.
- Can eyelid surgery be revised? Yes, though revision is usually deferred six to twelve months and is technically harder because tissue planes are scarred and skin is limited.
- What are the signs of a serious problem? Severe or escalating pain, sudden vision change, proptosis, or an inability to close the eye.
Complications and What Causes Them
| Problem | Cause | Management |
|---|---|---|
| Dry eye | Altered blink and lid closure, preexisting dry eye unmasked | Lubrication, usually temporary; preoperative screening reduces surprise |
| Chemosis | Conjunctival swelling, more common after lower lid work | Drops, patching, time |
| Asymmetry | Preexisting asymmetry, uneven healing, differing levator function | Observation, revision after maturation |
| Lower lid retraction or ectropion | Excess skin removal, unrecognized lid laxity, scar contracture | Massage, steroid, canthal support or grafting in established cases |
| Lagophthalmos | Over-resection of upper lid skin | Lubrication; severe cases may need grafting |
| Visible or webbed scar | Incision placement, tension, medial canthal web | Scar therapy or revision |
| Retrobulbar hematoma | Bleeding behind the orbital septum, rare | Emergency decompression; sudden pain and vision change require immediate care |
Over-Resection Is the Central Theme
Most durable eyelid complications trace to removing too much of something. Too much upper lid skin restricts closure.
Conservative resection with the option of a small secondary adjustment is generally safer than a single aggressive procedure, and it is a reasonable question to ask a surgeon directly.
What Reduces Risk
- Preoperative screening for dry eye symptoms and lid laxity, including a snap back or distraction test.
- Recognizing and treating lid laxity with canthal support rather than skin excision alone.
- Conservative skin marking with the patient upright and animated.
- Careful control of blood pressure and avoidance of antiplatelet agents where medically appropriate.
- Clear instructions for reporting pain or vision change immediately rather than waiting for a scheduled visit.
Limits of this answer
- Some findings cannot be fully corrected. Established lower lid retraction after over-resection often requires grafting and may not return the lid to its original position.
- Reported complication rates vary widely across series because definitions differ, particularly for dry eye and asymmetry, which are partly subjective.
- Perfect symmetry is not achievable. Eyes are asymmetric before surgery, and surgery reveals rather than creates most of that difference.
Frequently asked questions
- How common is dry eye after blepharoplasty?
- Temporary dryness is common. Persistent symptomatic dry eye is much less common and is more likely in patients who had dry eye before surgery.
- Can eyelid surgery be revised?
- Yes, though revision is usually deferred six to twelve months and is technically harder because tissue planes are scarred and skin is limited.
- What are the signs of a serious problem?
- Severe or escalating pain, sudden vision change, proptosis, or an inability to close the eye. These warrant immediate contact with the surgeon or an emergency department.
- Does the transconjunctival approach avoid ectropion?
- It avoids a skin incision and reduces the risk of skin shortening, which lowers but does not eliminate the risk of lid malposition.
Experience, expertise, authority, trust
- Experience
- Attending plastic surgeon, Lenox Hill Hospital, New York
- Expertise
- Triple board certified: ABPS, ABS, ABFPRS
- Authoritativeness
- Johns Hopkins faculty; 65 peer-reviewed papers on PubMed
- Trust
- Patient reviews reproduced verbatim, unedited, with sources
Related pages
Mansher Singh, MD, FACS what can go wrong with eyelid surgery? reviews and trust checks
642 verbatim patient reviews from the practice Google Business Profile, plus credentials you can confirm at the issuing source.
Consultation and contact
Mansher Singh, MD, FACS1035 Park Avenue, Suite E, New York, NY 10028
(646) 480-1709 · info@manshersinghmd.com
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